The Personalized External Aortic Root Support (PEARS) procedure is a contemporary strategy in the prophylactic management of aortic aneurysms, albeit formerly limited to the aortic root and ascending aorta. We describe an innovative surgical approach, termed the Personalized External Aortic Arch Support procedure, that enables the ExoVasc PEARS prosthesis (eXstent, England) to be extended in cases of concomitant aortic arch dilatation. This modification applies external reinforcement principles to “stabilize,” and thus “spare,” the native aorta from the aortic valve to the distal aortic arch; utilized with favorable early outcomes in Australasia. Advantages include the avoidance of circulatory arrest and cardiopulmonary bypass, with no interruption to cerebral perfusion. We consider that this novel technique could broaden the application of PEARS in selected patients to reduce the risk of aortic arch complications and the need for re-intervention.
The Ross procedure has re-emerged as an important surgical option for aortic valve replacement in carefully selected patients, supported by long-term data demonstrating excellent hemodynamics, durability, and safety. Notably, it remains the only operation capable of restoring normal life expectancy in select patients requiring aortic valve replacement. Despite these advantages, the procedure is performed by few surgeons worldwide and is often undertaken at low volumes with consequent unacceptable risk. The principal barrier to wider adoption is the complexity of the operation, with autograft implantation representing its most nuanced and technically demanding component. This article aims to demystify this critical aspect of the Ross procedure by presenting a simplified and systematic approach to autograft assessment and implantation, with the goal of enhancing reproducibility, safety, teachability, and utilization.
Severe pulmonary valve insufficiency complicates the management of many procedures requiring right ventricular outflow tract (RVOT) reconstruction. Originally described in Tetralogy of Fallot (TOF), neopulmonary valve reconstruction using right atrial (RA) appendage tissue has proven effective in restoring RVOT competence, out to at least out to 8-years in our experience. Certain technical considerations can facilitate efficient and reliable neopulmonary valve reconstruction. As surgeons gain experience and proficiency from routine cases, they can extend the application of RA appendage pulmonary valve reconstruction to more complex repairs.
The cardiac surgery community increasingly recognizes coronary surgery as a subspecialty requiring advanced technical skills and training. Every aspect of coronary artery bypass grafting has evolved to bring important benefits to patients and also greater complexity in operative technique. To harness the benefits of advanced coronary surgery and avoid associated pitfalls, mastery of the technical nuances must be achieved. This document provides a step-by-step primer on the techniques for routinely performing safe and reliable all-arterial no-aortic-touch off-pump coronary artery bypass grafting, summarizing lessons learned during a decade of evolution in a focused coronary surgical program.
Management of severe mitral valve stenosis in small children is challenging. Mitral valve replacement is often required and associated with high mortality and morbidity when performed in infants and young children. The technique of mitral valve reconstruction with autologous right atrial tissue may obviate the need for mitral valve replacement in small children.
